Healthcare Provider Details

I. General information

NPI: 1689161994
Provider Name (Legal Business Name): SHAWN YAVARI PHARM D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10769 N FRANK LLOYD WRIGHT BLVD STE A100
SCOTTSDALE AZ
85259-2670
US

IV. Provider business mailing address

9383 N 90TH STREET SUITE 102-240
SCOTTSDALE AZ
85258
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-4656
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS023184
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: